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Treatment To Prevent Fractures in Men and Women With Low Bone Density or Osteoporosis: An Update

Slide: 30 of 40

Adverse Effects of Medications for Low Bone Density or Osteoporosis (3 of 3)

The adverse effects associated with MHT (consisting of estrogen alone or estrogen in combination with progestin) are well known and extend to postmenopausal women taking the therapy for treatment of osteoporosis. The risk of cerebrovascular accidents is elevated by estrogen, with an odds ratio of 1.34-fold likelihood of a cerebrovascular accident (95 percent confidence interval [95% CI] of 1.07- to 1.68-fold). Combination therapy increases the risk with a 1.28-fold likelihood (95% CI from 1.05- to 1.57-fold). The strength of evidence in support of these findings is high.

The risk of thromboembolic events is elevated by estrogen, with an odds ratio of 1.36 -fold likelihood (95% CI of 1.01- to 1.86-fold). Combination therapy increases the odds again, with a 2.27-fold likelihood (95% CI from 1.72- to 3.02-fold). The strength of evidence in support of these findings is high.

Breast cancer risk was reported as an outcome of the WHI. Estrogen, as reported in Anderson et al. (2012), is associated with reduced incidence of breast cancer in women with hysterectomy when compared with placebo (hazard ratio [HR] = 0.77; 95% CI: 0.62 to 0.95), but subgroup analysis noted that the risk reduction was concentrated in women without benign breast disease or family history of breast cancer. No risk reduction was seen in women at high risk for breast cancer. In the WHI, as reported in Chlebowski et al. (2010), combination therapy is associated with more occurrences of invasive breast cancer than with placebo (HR = 1.25; 95% CI: 1.07 to 1.46), tumors more likely to have lymph node metastases (HR = 1.78; 95% CI: 1.23 to 1.58), and more breast cancer-related deaths (HR = 1.96; 95% CI: 1.00 to 4.04).